HomeMy WebLinkAboutApplication for Zoning Compliance11
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DATE FILED
PLAN REVIEW FEE: fS® —' RECEIPT NO.: • %y/91% Si PERMIT NUMBER:
CONCURRENCY PER 7 S RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
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St. Lucie County Building and Zoning /'�el�Lp��
2300 Virginia Avenue
�ORIOp' • Ft. Pierce, FL 3498Z-5652
ri �(MI.� 772-462-1553
L-A ` ` ` I C04 _ 0ff.50
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
2.
3.
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9.
10.
PROJECT INFORMATION `
LOCATION/SITE ADDRESS: C0 �-t ri ri lNh � ��7 �/� t- r `'
PROJECT NAME: 014 de { r SITE PLAN NAME: G ✓�^,P� %i%CJ" <S
PROPERTY TAX ID #: / r-j ? o — IL m ep o�l7
LEGAL DESCRIPTION (attach extra sheets if necessary):
PLAT BOOK 6. PAGE NO.
d,.v ~ -/VC Y vJ a&,.rt a .o� ,�
7. BLOCKNO._Z 8. LOT NO.
PARCEL SIZE (ACRES/SQ FT.): �LOT DIMENSIONS:
COMPLETE DESCRIPTION OF COONSTtRI/ICTION PROTECT O WORK ACTIVITY: 4r !G° GlY
c7 6 , /yl O CO i L`� /7 OM r Ovr ? +Z .Pr '%-7-
.2- 6e,Y,5"6 .e ^ a o S'o% eD I &rp
II. SETBACKS (ACTUAL) FRONT: ;"" BACK: iS RIGHT SIDE: t LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [I INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] OMMERCC����L [ ] INDUSTRIAL
[ ] OTHER (SPECIFY) ohpJ L - /`f o pft 0-
13. DESCRIPTION OF PROPOSED USE: 1 WWI,
14. SQ. FT OF CONSTRUCTION: / y 15, SR FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: $
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 a more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
OWNER INFORMATION
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NAME:
ADDREss: .�G n s� L� /d.0
CITY: o ✓I- 1 v%--c P STATE: I-Lo- 0 ZIP:
PHONE (DAYTIME): nb Email: '^
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE-, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ^— ZIP: —` - -
PHONE (DAYTIME): L_)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:;:7: /i j0d pn
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BUSINESS NAME: 19 f Ili 'r zVd 6 i `,-
QUALIFIERS NAME: _
ADDRESS:
CITY:
PHONE (DAYTIME):'
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BOND
ADDR
CITY:
MORT
ADDR
CITY:
SST.. LUCIE COUNTY CERT #: ) `t 4 `t
c� G e
✓ STATE: t's-� ZIP:
) /Q FAX NO20-poi%fi_OlEmail:
STATE:
IN
IN)PORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mail.
CERTIFICATION:
This application is hereby madeto obtain a permit todo the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any.. applicable Homeowner Association rules,. bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessoryuses to another non-
residential use.
NOTICE TO OWNER:
FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
_
RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT:
AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTEREST THAT ISSUBJECT TO ATTACHMENT; AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
' CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT.
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OWNER'S AFFIDAVIT:
I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
'MVnR OR CONTRACTOR
SIGNATURE NlRACTOIt SIGNATURE
STATE OF FLORIDA
COUNTY OF j- t_ L1 rC eo
The foregoing instrument was acknowledged before
/
me this i -t day of J-%-A N. P_ 20 /1)
by
who is personally known.%r has produced
as identification. --
STATE OF FLORIDA
COUNTY OF a 4 L( ccz
The foregoing instrument was acknowledged before
me this day of ,LLrJ e , 20JO
by
who is personally known _V_br has produced
as identification.
Si onto Signa re o NotaryROY .,
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Co ON#D %a2873 Co ROy MOTE(Neal)
MY COMMIS$10N' " 3742873
;, • • EXPIRES Decembe, 17, 2011 EXPIRES Qe
407 396 0153. ''
R' ,Q (407)388-0153 eemt, 7,2011
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NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOT YING FOR
THIS BUILDING PERMIT AS AN OWNERIBUH,DER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #: / D 0 is •'�oz 9
SECTION
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LAND USE
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LOT CVG %
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MAX HGT
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OCCUP TYPE
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WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
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LOT OF REC
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LOT SPLIT
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APPROVED
REPORT
CODE
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HABITABLE
AREA
(RADON)
RADON
FEE
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FEZEMMS
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SUES
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MECHANIC _ ROOF _
ELECTRIC GAS - _
PLUMBING t:
NON -CONFORMING
LOT OF RECORD
FEES
-
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
i
REVIEWS
FRONT
COUNM
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
Iti1I0
yREVIEW
DATE
COMPLETED
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INITIALS
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